Opening Our Hearts One Step at a Time: Debriefing With TEAMSTEPPS

Project Topic:

Improving Skillful Communication and True Collaboration among the ICU interdisciplinary team in emergent situations

Hospital, City and State:

Cedars-Sinai Medical Center, Los Angeles, California

Unit:

Cardiac Surgical Intensive Care Unit (CSICU)

CSI Participants:

• Sunju Cho, BSN, RN, CCRN-CSC
• Cameron Gilbert, BSN, RN, CCRN
• Nimish Joseph, BSN, RN, CCRN

Project Goals/Objectives:

1. Decrease nurse staffing turnover in an 11-month period from 7% to 5% (October 2023- September 2024)
2. Increase skilled communication and collaboration between nurses, advanced practice providers and physicians as measured by a 15% increase in the top 2 box percentage of our postclinical AACN Healthy Work Environment Assessment Tool (HWEAT) indicating “Excellent” or “Outstanding” ratings on each standard
3. Increase debriefing rates in the unit 100% in an 11-month period (October 2023- September 2024)

Project Outcomes:

1. Decreased nursing turnover rate from 6.9% to 5.8%
2. Increased HWEAT Skilled Communication score 15% in the top 2 box scores and an overall 3.2% increase in the aggregate score for all standards. The True Collaboration score increased 2.5% in the top 2 box scores and 1% overall in the standard score.
3. These outcomes resulted in a positive estimated annual fiscal impact of $104,700.

Project Overview:

The CSICU team noted ineffective communication and collaboration among CSICU team members in emergent situations. Nurses who are exposed to critical incidents may experience long-term physical and psychological impacts. Studies show that debriefings post critical incidents provide an opportunity to reflect on and learn from the incidents and may also reduce normalization of stressful situations. Therefore, the CSICU team implemented a TeamSTEPPS debriefing initiative to enhance emotional support among staff following critical events.

Despite challenges such as missed debriefings due to unstable patients, staff forgetting, absence of champions on some shifts and crises occurring during shift change, the project yielded significant positive outcomes. Staff reported increased peer recognition, more learning opportunities and stronger team rapport, which contributed to improved emotional support and morale.

Key lessons include the need for commitment from the multidisciplinary team, effective communication and reinforcement of the debriefing process. To sustain these benefits, we established monthly raffles to encourage participation, incorporated training for new champions and orientation of new staff, committed to staying updated on current research, planned regular data reviews to address ongoing needs, and refined the approach.

Project outcomes include increasing HWEAT aggregate scores and also True Collaboration and Skilled Communication scores. Staff surveys found that organizational satisfaction, closed loop communication, emergent situation satisfaction and emotional support satisfaction all increased. In addition, nurse turnover decreased 1.1%.